Intermittent pacing therapy for angina and disease prevention

Abstract

A pacing system delivers cardiac protective pacing therapy (CPPT) to protect the heart from injuries and/or to treat existing injuries. The pacing system receives a set of inputs and delivers optimized cardiac protection pacing tailored for each of different purposes. The system delivers electrical stimulation to provide therapy for angina and/or to provide therapy for co-morbidities related to neural imbalance. In one embodiment, a method for treating angina is provided. A signal is sensed indicative of an incidence of angina and an angina region being a myocardial region affected by the angina. The incidence of angina is detected and the angina region is located. A pacing location is selected remote from the angina region, and CPPT is initiated at the pacing location. The CPPT is adapted to create increased stress at the angina region, to promote mass-redistribution and angiogenesis at the angina region to treat the angina.

1 . A method, comprising:
 sensing a signal indicative of an incidence of angina and an angina region being a myocardial region affected by the angina;   detecting the incidence of angina and locating the angina region;   selecting a pacing location remote from the angina region; and   initiating cardiac protective pacing therapy (CPPT) at the pacing location adapted to create increased stress at the angina region, to promote mass-redistribution and angiogenesis at the angina region to treat the angina.   
   
   
       2 . The method of  claim 1 , wherein sensing a signal to detect an incidence of angina includes using a device-based method. 
   
   
       3 . The method of  claim 1 , wherein sensing a signal to detect an incidence of angina includes using an imaging-based method. 
   
   
       4 . The method of  claim 1 , wherein initiating CPPT includes initiating continuous pacing therapy. 
   
   
       5 . The method of  claim 1 , wherein initiating CPPT includes initiating intermittent pacing therapy. 
   
   
       6 . The method of  claim 5 , wherein initiating intermittent pacing therapy includes delivering pacing therapy in regular on/off pacing cycles. 
   
   
       7 . The method of  claim 6 , wherein initiating intermittent pacing therapy includes delivering pacing therapy with at least three cycles of on/off pacing. 
   
   
       8 . The method of  claim 7 , wherein initiating intermittent pacing therapy includes delivering pacing therapy with approximately  60  minutes of on/off pacing cycles. 
   
   
       9 . The method of  claim 1 , wherein initiating CPPT includes using ST elevation to cause mild ischemia, and to change the pacing mode and/or duration of pacing. 
   
   
       10 . The method of  claim 1 , further comprising:
 monitoring patient activity level; and   using the monitored level as an index of therapy efficacy in a closed loop system.   
   
   
       11 . A method, comprising:
 delivering cardiac protective pacing therapy (CPPT) to provide a cardiac conditioning therapy to improve neural balance;   monitoring neural balance and a parameter indicative of a selected co-morbidity related to neural imbalance; and   titrating the CPPT based on the monitored balance and parameter.   
   
   
       12 . The method of  claim 11 , wherein monitoring a parameter indicative of a selected co-morbidity includes allowing a physician to select the co-morbidity. 
   
   
       13 . The method of  claim 11 , wherein monitoring a parameter indicative of a selected co-morbidity includes monitoring a parameter of interest for sleep disordered breathing. 
   
   
       14 . The method of  claim 11 , wherein monitoring a parameter indicative of a selected co-morbidity includes monitoring a parameter of interest for apnea. 
   
   
       15 . The method of  claim 11 , wherein monitoring a parameter indicative of a selected co-morbidity includes monitoring a parameter of interest for atrial fibrillation (AF) burden. 
   
   
       16 . The method of  claim 11 , wherein monitoring a parameter indicative of a selected co-morbidity includes monitoring a parameter of interest for hypertension. 
   
   
       17 . The method of  claim 11 , wherein monitoring a parameter indicative of a selected co-morbidity includes monitoring a parameter of interest for renal dysfunction. 
   
   
       18 . The method of  claim 11 , wherein monitoring a parameter indicative of a selected co-morbidity includes monitoring apnea-hypopnea index (AHI). 
   
   
       19 . The method of  claim 11 , wherein titrating the CPPT includes continuing CPPT unchanged if the sensed parameter improves. 
   
   
       20 . The method of  claim 11 , wherein titrating the CPPT includes discontinuing CPPT unchanged if the sensed parameter degrades or is unchanged. 
   
   
       21 . The method of  claim 11 , wherein titrating the CPPT includes continuing CPPT with a new therapy mode if the sensed parameter degrades or is unchanged. 
   
   
       22 . A medical device for use in a body, comprising:
 a sensing circuit to receive sensed signal indicative of an incidence of angina and an angina region being a myocardial region affected by the angina;   a pacemaker circuit adapted to deliver an electrical signal through at least one electrode to a pacing location remote from the angina region; and   a controller to communicate with the sensing circuit and to control the pacemaker circuit to provide CPPT to the pacing location adapted to create increased stress at the angina region, to promote mass-redistribution and angiogenesis at the angina region to treat the angina.   
   
   
       23 . The device of  claim 22 , wherein the device includes an implantable cardiac rhythm management (CRM) pulse generator (PG) with intra-cardiac leads. 
   
   
       24 . A medical device for use in a body, comprising:
 a sensing circuit adapted to receive sensed signals indicative of neural balance and adapted to receive sensed parameters indicative of a selected co-morbidity related to neural imbalance;   a pacemaker circuit adapted to deliver an electrical signal through at least one electrode to a target location; and   a controller adapted to communicate with the sensing circuit and to control the pacemaker circuit to provide CPPT to the target location, and farther adapted to titrate the CPPT based on the sensed signals and parameters.   
   
   
       25 . The device of  claim 24 , wherein the selected co-morbidity includes sleep disordered breathing.